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Prescribing Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

prescribing Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE)

Seek expert advice and consult local guidelines.

PEP is not considered 100% effective, as there have been cases of HIV acquisition whilst on PEP. These may be related to

  • delayed initiation
  • transmission of resistant virus
  • variable genital tract drug penetration
  • poor/non-adherence
  • further high risk sexual exposures

Recommendations of British Association of Sexual Health and HIV (BASHH):

  • PEPSE should be used where there is a significant risk of HIV transmission
  • HIV status of source is
    • unknown - proactive attempts are made to establish the HIV status
    • known to be positive
      • attempts should be made at the earliest opportunity to determine the HIV viral load, resistance profile and treatment history
      • PEPSE is no longer recommended if the source is on antiretroviral therapy (ART) with a confirmed and sustained (>6 months) undetectable plasma HIV viral load (<200c/ml)
        • however, if there are any doubts about the HIV viral load history or the source "s adherence to ART then PEP should be given following unprotected receptive anal intercourse
  • truvada and raltegravir is the regimen of choice for PEPSE
  • PEPSE should be initiated as soon as possible after exposure, preferably within 24 hours, but can be considered up to 72 hours
    • giving PEPSE beyond 72 hours is not recommended
  • duration of PEPSE should be 28 days
  • follow-up HIV testing at 8-12 weeks after exposure should be carried out
  • pregnancy testing should be undertaken in women considering PEPSE
    • pregnancy should not alter the decision to start PEPSE
    • women must be counselled that antiretroviral agents used for PEPSE are unlicensed in pregnancy and risks / benefits must be carefully discussed
  • in the event of a further high-risk sexual exposure in the last two days of the PEPSE course the PEP should be continued for 48 hours after the last high-risk exposure
  • if the HIV test is positive after PEPSE has already been initiated we recommend continuing PEPSE pending review by an HIV specialist
  • individuals experiencing a skin rash or flu-like illness during or after taking PEPSE should be advised to attend for urgent review to exclude an HIV seroconversion illness

Guidance on missed doses of PEPSE:

  • <24 hours elapsed since last dose - take missed doses immediately and subsequent doses at usual time
  • 24-48 hours elapsed since last dose - continue PEPSE
  • >48 hours since last dose - recommend to stop PEPSE (1)

summary of PEPSE prescribing recommendations

 

source HIV status

 

HIV positive

unknown HIV status

 

HIV viral load unknown/detectable (>200 copies/ml)

HIV viral load undetectable (<200 copies/ml)

from high prevalence country / risk-group (e.g. MSM)

from low prevalence country/group

receptive anal sex

recommend

not recommended(provided source has confirmed HIV viral load <200copies/ml for > 6 months

recommend

not recommended

insertive anal sex

recommend

not recommended

consider

not recommended

receptive vaginal sex

recommend

not recommended

consider

not recommended

insertive vaginal sex

consider

not recommended

consider

not recommended

fellatio with ejaculation

not recommended

not recommended

not recommended

not recommended

fellatio without ejaculation

not recommended

not recommended

not recommended

not recommended

splash of semen into eye

not recommended

not recommended

not recommended

not recommended

cunnilingus

not recommended

not recommended

not recommended

not recommended

sharing of injecting equipment

recommend

not recommended

consider

not recommended

human bite

not recommended

not recommended

not recommended

not recommended

needlestick from a discarded needle in the community

 

 

not recommended

not recommended

Reference:

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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